Coronal. (you [are] so crazy)

OCD option for people who must vote, but don't know/care about SV sections.

So you want to section the prostate, and you need those Seminal Vesicle sections. What axis are your sections on? This is more for academic resident types, places where the prostate is total / near total submit. I guess private practice type and other could answer, too... I am more interested in the plane of section that the multiple sections thing, but wanted to cover the bases.

For staging, it's invasion of the seminal vesicles that's important, so a parasagittal section that includes the junction of the prostate proper and seminal vesicles seems to be the easiest single section for this.

You know, I always have difficulty with terms like parasagittal and axial. Which axis? How much para? What does that even mean? I need to see a diagram.

We take cross sections of the seminal vesicles (perpendicular to the long axis of the seminal vesicle), one at the portion immediately adjacent to the prostate, and one from midway along it. Personally, I disagree with doing it that way, I would take a section that includes a portion of seminal vesicle and a portion of prostate, so that you can see exact relationships.

You know, I always have difficulty with terms like parasagittal and axial. Which axis? How much para? What does that even mean? I need to see a diagram.

We take cross sections of the seminal vesicles (perpendicular to the long axis of the seminal vesicle), one at the portion immediately adjacent to the prostate, and one from midway along it. Personally, I disagree with doing it that way, I would take a section that includes a portion of seminal vesicle and a portion of prostate, so that you can see exact relationships.

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Actually so do I, but horizontal and vertical don't sound very correct. I would have said perpendicular to the long axis of the urethra, but I have seen people thing that perpendicular to a tube mean a cut that radiates from it is 'perpendicular' to it...

I should have just said are your seminal vesicle sections cross sectional lumen or longitudinal.

we bivalve the prostate into L/R (after taking apical/bladder neck margins), serial section from apex to base, submit several rep sections, esp. ones toward the back (base) that include SV. Not sure if that coordinates as axial, radial, coronal, longitudinal, sagital, cross sectional, or whatnot as i'm always confused about these vague orientation, but seems like others do it similarly?

we bivalve the prostate into L/R (after taking apical/bladder neck margins), serial section from apex to base, submit several rep sections, esp. ones toward the back (base) that include SV. Not sure if that coordinates as axial, radial, coronal, longitudinal, sagital, cross sectional, or whatnot as i'm always confused about these vague orientation, but seems like others do it similarly?

Click to expand...

That would be Axial or horizontal, and not the way most people are doing it.

Ok to clear this up:
Sagital is a plane in the midline it splits right and left halves. Parasagital is technically any plane parallel to that plane. Or if the edges of yous slide are Ant, post, sup, inf that is parasagital.

Transverse, axial or horizontal. or perpendicular to the urethra. If your slides edges are left, right (or midline, lateral) and ant, post thats transverse.

Coronal. Perpendicular to the other two. If your slide edges are sup, inf, lat, medial that is coronal.

We have an interesting way of grossing prostates:
We section the prostate anterior to posterior (along the apex-base axis) through the urethra. Then we section each half into quadrants (again using an apex-base axis). We thus establish left anterior, right anterior, left posterior, & right posterior quadrants. We then submit 4 sections per quadrant (and usually favor sections toward the base).

Seminal vesicles we bivalve in situ, and submit one half of each (or so) along with the attached prostate.

we bivalve the prostate into L/R (after taking apical/bladder neck margins), serial section from apex to base, submit several rep sections, esp. ones toward the back (base) that include SV. Not sure if that coordinates as axial, radial, coronal, longitudinal, sagital, cross sectional, or whatnot as i'm always confused about these vague orientation, but seems like others do it similarly?

Click to expand...

i went back and checked with some of our PAs and it seems like a few indeed do a sag/mid sag whatever sectioning of SV (i.e. your slides contains a long segment of sv going into prostate). Key thing (staging-wise) is if sv are involved, and they're likely to be involved at the junction of the prostate so however you can accomplish sectioning this area best is ideal. seems odd to take sections of the sv tip, as i've heard (not here i guess on this forum) some places/books do/teach.

what margins do people take? (i'm mainly wondering if folks take vas margins, as the Hruban grossing manual suggests).

We have an interesting way of grossing prostates:
We section the prostate anterior to posterior (along the apex-base axis) through the urethra. Then we section each half into quadrants (again using an apex-base axis). We thus establish left anterior, right anterior, left posterior, & right posterior quadrants. We then submit 4 sections per quadrant (and usually favor sections toward the base).

Seminal vesicles we bivalve in situ, and submit one half of each (or so) along with the attached prostate.

I also do not know if this is parasagittal sectioning, etc...

Mindy

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I don't think that technique is that unusual. The way we do it here is basically similar. They are sliced anterior-posterior, and we submit the entirety of every other slice, with each quadrant going into one block (thus, 4 blocks per slice, one is left anterior, one left posterior, etc). It is a somewhat modified version of whole-mount sectioning, as you can theoretically recreate the whole mount by fitting the four slides together to make the whole slice. It works well for localizing tumors and determining multifocality. The margins are separate. But this is why we do seminal vesicles as perpendicular sections.

Our grossing template:

First two blocks are vas margins and portions of each seminal vesicle
Second two blocks are distal urethral margin
Blocks 5-6 are proximal margin (bladder neck) - both DUM and PUM are cones that are serially sectioned, basically
Block 7 is mid portion of seminal vesicles
8-11 is slice one (towards base)
12-15 is slice 3 (towards base)
etc, depending on how big the prostate is and how many slices.

I don't think that technique is that unusual. The way we do it here is basically similar. They are sliced anterior-posterior, and we submit the entirety of every other slice, with each quadrant going into one block (thus, 4 blocks per slice, one is left anterior, one left posterior, etc). It is a somewhat modified version of whole-mount sectioning, as you can theoretically recreate the whole mount by fitting the four slides together to make the whole slice. It works well for localizing tumors and determining multifocality. The margins are separate. But this is why we do seminal vesicles as perpendicular sections.

Our grossing template:

First two blocks are vas margins and portions of each seminal vesicle
Second two blocks are distal urethral margin
Blocks 5-6 are proximal margin (bladder neck) - both DUM and PUM are cones that are serially sectioned, basically
Block 7 is mid portion of seminal vesicles
8-11 is slice one (towards base)
12-15 is slice 3 (towards base)
etc, depending on how big the prostate is and how many slices.

I don't think that technique is that unusual. The way we do it here is basically similar. They are sliced anterior-posterior, and we submit the entirety of every other slice, with each quadrant going into one block (thus, 4 blocks per slice, one is left anterior, one left posterior, etc). It is a somewhat modified version of whole-mount sectioning, as you can theoretically recreate the whole mount by fitting the four slides together to make the whole slice. It works well for localizing tumors and determining multifocality. The margins are separate. But this is why we do seminal vesicles as perpendicular sections.

Our grossing template:

First two blocks are vas margins and portions of each seminal vesicle
Second two blocks are distal urethral margin
Blocks 5-6 are proximal margin (bladder neck) - both DUM and PUM are cones that are serially sectioned, basically
Block 7 is mid portion of seminal vesicles
8-11 is slice one (towards base)
12-15 is slice 3 (towards base)
etc, depending on how big the prostate is and how many slices.

Click to expand...

This sounds very close to what I do. I usually end up with 20-30 slides.

Some of the attendings that I had would frown upon a prostate taking up more than a single flat, ie 20 blocks (node dissection excluded, of course).

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Well, it's pretty standard to go 20+ in many academic centers. There are many institutions where it is actually standard procedure to submit the entire thing (35-40 blocks). Some do this via whole mount procedure which I think is a nice way to see it (although technically difficult for histology, and obviously not that amenable to immunostains within rembedding in smaller blocks).

Well, it's pretty standard to go 20+ in many academic centers. There are many institutions where it is actually standard procedure to submit the entire thing (35-40 blocks). Some do this via whole mount procedure which I think is a nice way to see it (although technically difficult for histology, and obviously not that amenable to immunostains within rembedding in smaller blocks).

Click to expand...

I don't doubt that its done, I was just conveying what I've had requested of me. I had the opportunity to see the whole mount prostates at MSKCC last summer and I have to say that they are pretty awesome.

jeez, i strive to not go over 18ish. I'm trying to prep for private practice which i've heard often puts in around 10 sometimes. How do other private folks out there handle it?

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I think some people only thoroughly sample the posterior portion of the prostate, so that would be one way of cutting down on slides. I just find that it doesn't really cut down on my time expended, so I don't worry about it. I also abhor going back to the bucket, so if in doubt I usually submit more (of course, that attitude may change once profit margins and expenses truly affect me).

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